| NPI | 1134700776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 287991) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 287991) |
| 2086S0127X Surgery, Trauma Surgery (Licence: MA 287991) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2021-09-16 |