| NPI | 1265894315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 88787) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0150255) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2022-10-10 |