| NPI | 1891101317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0059207) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0005275) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2021-09-13 |