| NPI | 1881273480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301517897) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2026-04-30 |