| NPI | 1417392903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: OH 35.134526) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 31131) |
| 208600000X Surgery (Licence: TX s7920) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 171000000X Military Health Care Provider (Licence: OK 31131) | |
| 171000000X Military Health Care Provider (Licence: TX s7920) | |
| 208600000X Surgery (Licence: OH 35.134526) | |
| 171000000X Military Health Care Provider (Licence: OH 35.134526) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 34.134526) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OK 31131) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX s7920) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: OK 31131) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: TX s7920) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2022-08-11 |