| NPI | 1881172567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 323190) |
| Additional Taxonomies | 247000000X Technician, Health Information |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2023-09-26 |