| NPI | 1013174598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036124910) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD434356) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-10-26 |