| NPI | 1750722401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 78996) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S7190) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 208C00000X Colon & Rectal Surgery (Licence: TX S7190) | |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2026-05-27 |