| NPI | 1114284908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME117612) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 117612) |
| 208600000X Surgery (Licence: GA 078019) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN17193) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2018-09-05 |