| NPI | 1851703748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 304507) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: NJ 25ma11516600) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2022-06-21 |