| NPI | 1396056404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NV 16681) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301108393) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2023-05-02 |