| NPI | 1275851768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0082611) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197069) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.020479) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197069) | |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2024-10-07 |