| NPI | 1780099135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 11590) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA MD-45898) |
| 208600000X Surgery (Licence: NE 31594) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-10078) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2025-12-23 |