| NPI | 1730599770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 89659) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 201213) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2021-08-16 |