| NPI | 1609035021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CT 51720) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 233447) |
| 208600000X Surgery (Licence: RI MD15107) | |
| 208600000X Surgery (Licence: CT 51720) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 051720) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2018-07-25 |