| NPI | 1750762001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AZ 65328) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125067431) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2023-11-30 |