| NPI | 1891431680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125083537) |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2025-04-05 |