| NPI | 1265810808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-02673) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NC 2022-02673) |
| 208600000X Surgery (Licence: RI MD17896) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351042214) | |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2022-09-28 |