| NPI | 1366645574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301084241) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301084241) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301084241) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2023-11-27 |