| NPI | 1023496940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OK 39325) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: MD D0091959) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2022-05-21 |