NPI | 1356879035 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 5101025681) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 5101025681) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-05-25 |
Last Update Date | 2023-07-21 |