| NPI | 1124345905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: OH 35128918) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: PA MD460397) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2019-06-19 |