| NPI | 1932256815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 268216-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: TN MD0000041437) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2013-05-23 |