| NPI | 1780948141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 75180) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 56367) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: CT 75180) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: CT 75180) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2025-05-07 |