| NPI | 1275891384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 293853) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 50205) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2018-10-19 |