| NPI | 1972858421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34012460) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 31-0564121) |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2020-11-19 |