| NPI | 1063738177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: KY 52875) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: CT 56861) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2022-08-29 |