| NPI | 1942464144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 0061105) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT192047) |
| 208600000X Surgery (Licence: NE 6817) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT192047) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2023-06-01 |