| NPI | 1326434556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: FL OS16687) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO3919) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2020-10-20 |