| NPI | 1417451097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 125.072378) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: NC 2023-01997) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-07-31 |