| NPI | 1720645260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 329988-01) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT217733) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2024-06-19 |