| NPI | 1083055461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TN 61511) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 37179) |
| 208600000X Surgery (Licence: FL TRN19019) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209288) | |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2022-01-29 |