| NPI | 1750701801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: PA MD470798) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 62213) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2020-08-17 |