| NPI | 1306189931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MT219531) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD458960) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2021-07-21 |