| NPI | 1871945956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT211913) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT211913) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2020-09-25 |