| NPI | 1922685643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: GA 111380) |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2026-03-26 |