| NPI | 1821437344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 132067) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 193300) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2021-08-20 |