| NPI | 1033302062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: ND 11255) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: TX K2328) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2022-03-29 |