| NPI | 1760621114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101269444) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 201100667) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME101034) | |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2020-06-29 |