| NPI | 1376078014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NY 322386) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT219423) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2025-05-06 |