| NPI | 1801470331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10075640) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX W2355) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2026-05-12 |