| NPI | 1205015427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME105441) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME105441) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN11783) | |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2021-10-28 |