| NPI | 1265055198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT220564) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MT220564) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT220564) | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2024-08-15 |