| NPI | 1912218173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101250184) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101250184) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2024-03-05 |