| NPI | 1861835209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV LL2861) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: PA MT209322) | |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2016-06-29 |