| NPI | 1871120691 |
|---|---|
| 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: IL 036-174086) |
| 208C00000X Colon & Rectal Surgery (Licence: IL 036-174086) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2026-07-16 |