| NPI | 1043444094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: CA A166825) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: IL 036135232) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2021-03-15 |