| NPI | 1962767491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-45546) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: IA MD-45546) |
| 2086S0102X Surgery Surgical Critical Care (Licence: IA MD-45546) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2023-11-16 |