| NPI | 1942568118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID O-1290) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD H84622) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 26696205) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2019-10-17 |