| NPI | 1912341447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 306605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63283) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2021-09-07 |