| NPI | 1013275627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: TX R9036) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 0000050930) |
| 2086S0102X Surgery Surgical Critical Care (Licence: TN 50930) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2022-03-22 |