| NPI | 1255713772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME146090) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R3783) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2020-06-24 |