| NPI | 1801327184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: KY 56726) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R4443) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2086S0129X (Licence: FL ME179908) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2026-08-05 |