| NPI | 1952983769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 326378) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 326378) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2021-04-22 |