| NPI | 1922590447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R76979) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R76979) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-06-12 |