| NPI | 1205147022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: SC 52219) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 62079) |
| 208600000X Surgery (Licence: SC 52219) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2022-07-21 |