| NPI | 1598044299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 324394) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 63164) |
| 208C00000X Colon & Rectal Surgery (Licence: AZ 63164) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2023-07-11 |