| NPI | 1942589213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0056891) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-4069) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2022-01-21 |