| NPI | 1295859379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 283349) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV ll1566) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2023-03-07 |