| NPI | 1952537847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 286667) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: TN 43355) | |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2016-11-29 |