| NPI | 1073174678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-17872) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT219075) |
| 208600000X Surgery (Licence: PA MT219075) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2024-10-07 |