| NPI | 1801250709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME149669) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101274224) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2022-08-10 |