| NPI | 1851553325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 61311) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL10279) |
| 208C00000X Colon & Rectal Surgery (Licence: ND PT12950) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME109661) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2024-06-20 |