| NPI | 1174919765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: TN 71312) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036159220) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2024-07-13 |