| NPI | 1881459923 |
|---|---|
| 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: NY 332963) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2025-12-04 |