| NPI | 1780813592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME123398) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME123398) |
| 2086S0127X Surgery, Trauma Surgery (Licence: FL ME123398) | |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2017-01-10 |