| NPI | 1922361641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A127272) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL ME135454) |
| 208C00000X Colon & Rectal Surgery (Licence: CA A127272) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2025-08-27 |