| NPI | 1952421208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME128595) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0120X Surgery, Pediatric Surgery (Licence: FL ME128595) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2017-01-25 |