| NPI | 1619104213 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD487802) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301105996) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MI 4301105996) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: MI 4301105996) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105996) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2025-01-21 |