| NPI | 1508245531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME132847) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 83741) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 21165) | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2023-01-11 |