| NPI | 1508934555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: FL ME110757) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2009-01041) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-02-21 |