| NPI | 1720442999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT017447) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2021-02-17 |