| NPI | 1881120343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 32282) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10059234) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2022-07-26 |