| NPI | 1619438280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.074786) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2026-08-04 |