| NPI | 1063807774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 04-46768) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT211330) |
| 208C00000X Colon & Rectal Surgery (Licence: IL 125.077903) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2023-04-24 |