| NPI | 1821351099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0127X Surgery, Trauma Surgery (Licence: WA MD60862280) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A131054) |
| 208600000X Surgery (Licence: WA MD60862280) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2018-07-19 |