| NPI | 1417274028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: KY 49490) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY TP302) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2020-06-03 |