| NPI | 1902232952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 86679) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-022723) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2022-12-20 |