| NPI | 1861142044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 125.079734) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 1861142044) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-10-03 |