| NPI | 1346800091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MD D0102672) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 279442) |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2025-08-22 |