| NPI | 1699918169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD60858867) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OR MD179551) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2018-09-05 |