| NPI | 1871020529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2023-0547) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0006516) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2023-05-30 |