| NPI | 1881228260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.031756) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 58.031756) |
| 208600000X Surgery (Licence: OH 58.031756) | |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-05-27 |