| NPI | 1124218128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME109259) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT186813) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2024-01-16 |