| NPI | 1952627853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OH 35.129254) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD456123) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2018-02-26 |