| NPI | 1619408937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: TN 74243) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA ml60781919) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-07-28 |