| NPI | 1336702406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MD D0104273) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: PA MD486756) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2026-07-17 |