| NPI | 1407019177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: WA MD60916305) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60916305) |
| 2086S0127X Surgery Trauma Surgery (Licence: VT 042.0013451) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR LL17835) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2021-02-19 |