| NPI | 1982193629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301509726) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351034486) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2023-08-02 |