| NPI | 1952004434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 78376) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 33417) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2024-06-10 |