| NPI | 1871975896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2019046474) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10053644) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2020-06-28 |