| NPI | 1104276542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA11200600) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: ID MC-2472) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: IN 01092242A) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208600000X Surgery (Licence: GA 92472) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2025-01-20 |