| NPI | 1245989854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MB12606300) |
| 208600000X Surgery (Licence: PA OS025246) | |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-07-29 |