| NPI | 1023499423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TN 63430) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 63430) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-09-23 |