| NPI | 1386965481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: WI 73288) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 73288) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT197240) | |
| Enumeration Date | 2010-06-13 |
| Last Update Date | 2021-02-05 |