| NPI | 1821758632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: TX 48456) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2024-10-01 |