| NPI | 1013111889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX P4065) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN#11220) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-03-17 |