| NPI | 1073877858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO209456) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101025855) |
| 2086S0127X Surgery, Trauma Surgery (Licence: MI 5101025855) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2022-03-21 |