| NPI | 1912344581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 263104) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME145670) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2023-05-18 |