| NPI | 1487752796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME100881) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 100881) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME100881) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-07-21 |