| NPI | 1932697307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 83204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 239436) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2024-07-15 |