| NPI | 1619167517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD434211) |
| Additional Taxonomies | 2086X0206X Surgery Surgical Oncology (Licence: LA MD.026385) |
| 208600000X Surgery (Licence: LA MD.026385) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 26385) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2020-12-17 |