| NPI | 1568849230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S6925) |
| 208C00000X Colon & Rectal Surgery (Licence: MA T289932) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2023-04-14 |