| NPI | 1417142795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD420177) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN11132) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2018-04-13 |