| NPI | 1881988582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: KY TP364) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 173420) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2019-05-22 |