| NPI | 1104453810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 334720) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 334720) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64393) | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-07-08 |