| NPI | 1073711164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA FR3721075) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT184330) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2022-07-13 |