| NPI | 1760914345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID o-1843) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR DO216497) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ID MSO-0196) | |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2023-08-03 |