| NPI | 1952625576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: VA 0101264407) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109915) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2021-08-11 |