| NPI | 1336674365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME142395) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0086329) |
| 208D00000X General Practice (Licence: FL ME142395) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2023-04-13 |