| NPI | 1811482946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301508963) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT216458) |
| Enumeration Date | 2018-07-01 |
| Last Update Date | 2023-06-27 |