| NPI | 1083093595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME152585) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 21582) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2021-10-15 |