| NPI | 1053510339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N6127) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX N6127) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2015-11-16 |