| NPI | 1881217321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-11818) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2021-04-26 |