| NPI | 1700153236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 12998-I) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19844) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 951285) | |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2022-11-02 |