| NPI | 1386905453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301100457) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: PA MD473939) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100457) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2023-10-18 |