| NPI | 1922503598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX T1153) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX T1153) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: TX T1153) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2024-12-16 |