| NPI | 1255864674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME137273) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME137273) |
| 208600000X Surgery (Licence: FL TRN24935) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2019-06-29 |