| NPI | 1417290248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 136863) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101258942) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT216590) | |
| 208600000X Surgery (Licence: PA MT216950) | |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2023-10-24 |