| NPI | 1154883452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 70715) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 70715) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 89834) | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2025-03-06 |