| NPI | 1841624731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 87251) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL37087) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 29636) | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2020-12-07 |