| NPI | 1235526591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA11864000) |
| Additional Taxonomies | 208600000X Surgery (Licence: MT 142708) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2024-06-27 |