| NPI | 1851612006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MA 269601) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 243771) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2021-01-27 |