| NPI | 1740441443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA09618900) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R70529) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME116873) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2019-12-31 |