| NPI | 1972981215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 67557-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 6055-851) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2017-07-12 |