| NPI | 1902283211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 272930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 272930) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2024-03-28 |