| NPI | 1831764240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 1508942525) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-12-08 |