| NPI | 1609371699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A209517) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: NJ 25ma13347100) | |
| 208600000X Surgery (Licence: NY 336857) | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2026-10-15 |