| NPI | 1154001808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT231174) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4352001139) |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2024-06-30 |