| NPI | 1306376173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301510107) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301510107) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351049461) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-07-29 |