| NPI | 1700558418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MTL500001537) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT225223) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2022-04-14 |