| NPI | 1073824975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD467438) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI MD16311) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2021-03-02 |