| NPI | 1003107244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2018017277) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 277473) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2020-06-29 |