| NPI | 1679981575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A179424) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA10599100) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CA A179424) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2024-03-27 |