| NPI | 1194044719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 267272) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: ME MD23041) | |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2023-03-07 |