| NPI | 1093195315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 184162) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 285418) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 285418) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2023-03-27 |