| NPI | 1720345572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME151323) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: WI 71621) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2023-02-03 |