| NPI | 1336689108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 5101027281) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: MI 5101027281) | |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2024-10-08 |