| NPI | 1144759895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT213925) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT213925) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2019-07-25 |