NPI | 1578903050 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 73128) |
Additional Taxonomies | 208600000X Surgery (Licence: VA 0101256721) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-06-28 |
Last Update Date | 2025-07-31 |