| NPI | 1295987139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N1808) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: TX N1808) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX TMBPIT#BP10017030) | |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2026-07-07 |