| NPI | 1588921647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 312449) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 312449) |
| 208600000X Surgery (Licence: FL ME137853) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2021-08-31 |