| NPI | 1609019934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX Q3108) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q3108) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2021-04-12 |