| NPI | 1013108174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: LA MD.202367) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA GETP.LSU.GS) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2023-03-07 |