| NPI | 1134562960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL MD141370) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301103396) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103396) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2019-06-18 |