| NPI | 1790055291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME116714) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q0888) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-12-31 |
| Last Update Date | 2017-10-31 |