| NPI | 1932256815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX W0737) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD0000041437) |
| 208600000X Surgery (Licence: NY 268216-1) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2025-09-02 |