| NPI | 1912380221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10078313) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01086267A) |
| 208600000X Surgery (Licence: MI 4301108382) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2022-06-11 |