| NPI | 1538425319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 289067) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63244) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-06-11 |