| NPI | 1033524756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 319022) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.065598) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-05-23 |