| NPI | 1497119960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A193634) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ 000000000000) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2024-12-17 |