| NPI | 1033472519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MT MED-PHYS-LIC-69777) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208600000X Surgery (Licence: WI 1033472519) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2022-01-25 |