| NPI | 1932543030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A154172) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT204908) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-20 |
| Last Update Date | 2020-04-08 |