| NPI | 1134756893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME170580) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-05-21 |