| NPI | 1831325356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 83679) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 8406595-1205) |
| 208600000X Surgery (Licence: LA 301950) | |
| 208600000X Surgery (Licence: MS 21459) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2019-10-17 |