| NPI | 1952507972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 24781) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP2-0035874) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10028685) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2022-04-05 |