| NPI | 1801086129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S6472) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA MD.200238) |
| 2086X0206X Surgery Surgical Oncology (Licence: TX S6472) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 200238) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2022-06-15 |