| NPI | 1205199874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 271766) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: MD D85611) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 252467) | |
| 208C00000X Colon & Rectal Surgery (Licence: PA MT214631) | |
| 208C00000X Colon & Rectal Surgery (Licence: MA 271766) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2023-01-10 |