| NPI | 1326367848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME133362) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A121737) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2018-01-16 |