| NPI | 1285870428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA104181000) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A109722) |
| 208600000X Surgery (Licence: NY 296463) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2019-01-30 |