| NPI | 1841443645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P9596) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN12786) |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2016-09-17 |