| NPI | 1922493352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2021-01361) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NC 2021-01361) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-09-08 |