| NPI | 1700084522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P7575) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX P7575) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016495) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2016-11-28 |