| NPI | 1104313196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB11851800) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2024-03-28 |