| NPI | 1033465695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0078799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D78799) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT202981) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2019-10-16 |