| NPI | 1629538558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT227424) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: PA 1629538558) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2022-09-20 |