| NPI | 1801112024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0105X Surgery, Surgery of the Hand (Licence: WA MD60658821) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2021-12-17 |