| NPI | 1720493729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 304104) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME152633) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2022-12-08 |