| NPI | 1306512579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11022501A) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 2086S0102X) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2022-07-08 |