| NPI | 1851772057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301505824) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.158803) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125067329) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2022-02-07 |