| NPI | 1255574570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: RI MD15022) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301104499) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 156878) | |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2020-01-29 |