| NPI | 1649447806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-9315) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: AR E-9315) |
| 2086S0129X (Licence: AR E-9315) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2026-05-12 |