| NPI | 1073975892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: VA 0101274267) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: IL 99999999999999999999) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-07-15 |