| NPI | 1013396522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 21806) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT209046) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2021-09-02 |