| NPI | 1558628677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: IA MD-47879) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 56317) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CT 56317) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2021-03-04 |