| NPI | 1235450370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL OS13926) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT013773) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4558) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2016-09-30 |