| NPI | 1811195498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: PA OS014842) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: PA OS014842) |
| 2086S0102X Surgery Surgical Critical Care (Licence: NV 1354) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV LL0428) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2021-06-30 |