| NPI | 1033437074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 64165) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX Q5498) |
| 208C00000X Colon & Rectal Surgery (Licence: TX Q5498) | |
| Enumeration Date | 2010-05-15 |
| Last Update Date | 2020-01-08 |