| NPI | 1861916520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 88529) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 010657) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2023-06-06 |