| NPI | 1043647290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX S1700) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD448706) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2020-03-02 |