| NPI | 1174919526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery Trauma Surgery (Licence: NY 301983) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NY 301983) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2021-07-15 |