| NPI | 1528416989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 316992) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2021024760) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2023-01-05 |