| NPI | 1801115530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: GA 81959) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME136430) |
| 2086S0127X Surgery, Trauma Surgery (Licence: FL ME136430) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 165185) | |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2022-11-14 |