| NPI | 1053562967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101265513) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A11662) |
| 208600000X Surgery (Licence: PA MD459746) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101265513) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2022-12-05 |