| NPI | 1891969937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: CT 66791) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2013-00912) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2020-10-12 |