| NPI | 1982813283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 88461) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116017240) |
| 208600000X Surgery (Licence: VA 0101253123) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2024-08-08 |