| NPI | 1255505053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 122307) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA 122307) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2022-07-21 |