| NPI | 1053947085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 14275593-1205) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: UT 14275593-1205) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2026-07-11 |