| NPI | 1578683231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301077820) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.095889) |
| 208600000X Surgery (Licence: MI 4301077820) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301077820) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2018-07-19 |