| NPI | 1639433659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO21431516) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS018962) |
| 2086S0127X Surgery, Trauma Surgery (Licence: OR DO214315) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2023-11-21 |