| NPI | 1073926432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 66926) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R74518) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-11-11 |