| NPI | 1124438544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX U0105) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD24082) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-12-16 |