| NPI | 1891144283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.016228) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: KS 05-51245) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-10-02 |