| NPI | 1720220205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD456815) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S0928) |
| 208600000X Surgery (Licence: PA MT194185) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194185) | |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2022-01-10 |