| NPI | 1386843894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OR MD154771) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA MD60540689) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR LL16897) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2022-02-04 |