| NPI | 1932374808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO151685) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-1790) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2012-11-06 |