| NPI | 1760057699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0116035112) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2022-08-28 |