| NPI | 1255820296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MB11781500) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: NJ 25MB11781500) | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2024-04-24 |