| NPI | 1235792516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: PA MD496317) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 25996) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: NV 25996) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2026-07-28 |