| NPI | 1275951212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2021-0969) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NM MD2015-0677) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2023-11-17 |