| NPI | 1740547652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OK 35109) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 303941) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2019-09-17 |