| NPI | 1659719904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 318545) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: NY 318545) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2023-02-27 |