| NPI | 1023481629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: OR MD200453) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD200453) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2021-03-01 |