| NPI | 1053522052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME121404) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2016-11-15 |