| NPI | 1730609371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA Os019576) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: PA OT017695) | |
| Enumeration Date | 2017-06-25 |
| Last Update Date | 2022-07-19 |