| NPI | 1033409867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 290183) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME127339) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63106) | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2022-07-21 |