| NPI | 1336554716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036-157444) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD H0089469) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151013905) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-12-21 |