| NPI | 1386858157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 27784) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.099572) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2023-06-29 |