| NPI | 1285048199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: PR 21572) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: PR 21572) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: PR 21572) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-10-01 |