| NPI | 1841578416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 91926) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199669) |
| 208600000X Surgery (Licence: PA MT199669) | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2022-05-27 |