| NPI | 1144632266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A143289) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: TX BP10065939) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2024-08-19 |