| NPI | 1285952002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NC 2016-00657) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME122679) |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2021-11-11 |