| NPI | 1013396647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME150536) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT207971) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2025-04-30 |