| NPI | 1730574161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 312741) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD469796) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MD469796) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-08-31 |