| NPI | 1982229357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101274942) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2026-07-15 |