| NPI | 1912437070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2022041554) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10059231) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2023-07-11 |