| NPI | 1780063057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 63323) |
| Additional Taxonomies | 204F00000X Transplant Surgery (Licence: TN 63323) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107007) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2023-08-27 |