| NPI | 1730316456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: OH 35136881) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2009013686) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301109273) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME131871) | |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2019-07-11 |