| NPI | 1629465752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: FL OS17637) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 285382) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2021-09-11 |