| NPI | 1033640156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 82696) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 65813) |
| 208C00000X Colon & Rectal Surgery (Licence: MN 65813) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2024-08-08 |