NPI | 1538556428 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0129X (Licence: NJ 25MA12291700) |
Additional Taxonomies | 208600000X Surgery (Licence: NC 2022-01950) |
208600000X Surgery (Licence: NJ 25MA12291700) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-04-19 |
Last Update Date | 2025-10-03 |