| NPI | 1336312131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 265530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 265530-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2019-06-04 |