| NPI | 1649834193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: CT 78237) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 76747) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-08-12 |