| NPI | 1619001468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 249922) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036118047) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT 060-0003317) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2024-04-03 |