| NPI | 1699988170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101245399) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018383) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-05-03 |