| NPI | 1861021727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT221767) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-09-28 |