| NPI | 1952543548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA10420500) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101252956) |
| 208600000X Surgery (Licence: MD D70606) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2018-10-01 |