| NPI | 1881481059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 111910) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208C00000X Colon & Rectal Surgery (Licence: GA 111910) | |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2026-05-21 |