| NPI | 1861888794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A20785) |
| Additional Taxonomies | 204F00000X Transplant Surgery (Licence: OH 34.014908) |
| 207Q00000X Family Medicine (Licence: AZ 008110) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2023-09-08 |