| NPI | 1558716472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0099391) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MD D0099391) |
| 2086S0127X Surgery, Trauma Surgery (Licence: MD D0099391) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME175868) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2025-11-17 |