| NPI | 1104015056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: NJ 25MA08635100) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: VA 0101243802) | |
| 208600000X Surgery (Licence: NJ 25MA08635100) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2011-09-21 |