| NPI | 1598175143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME166361) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: AL 38267) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2024-09-17 |