| NPI | 1760845226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 35238) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 73842) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2025-09-29 |