| NPI | 1770993172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 277073) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 291729) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: MA 277073) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-06-29 |