| NPI | 1174866396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME140312) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 140312) |
| 208C00000X Colon & Rectal Surgery (Licence: TN 54588) | |
| 208C00000X Colon & Rectal Surgery (Licence: MS 29970) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2022-03-29 |