| NPI | 1356601645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: LA 303406) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 303406) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME134788) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2022-11-07 |