| NPI | 1679731202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P6990) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME116330) |
| 208C00000X Colon & Rectal Surgery (Licence: TX P6990) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN12571) | |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2023-12-17 |