| NPI | 1891258158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ R77324) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 1891258158) |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2019-12-02 |