| NPI | 1225292477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD437392) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT184815) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2019-03-26 |