| NPI | 1508220229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 23361) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63702) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2022-12-08 |