| NPI | 1780984658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35.125225) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 75376) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.018576) | |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2020-09-25 |