| NPI | 1710220421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 22424) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD473359) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-03-26 |