| NPI | 1154609626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD469424) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 40042) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2021-04-09 |