| NPI | 1083077481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301509622) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61579287) |
| 208C00000X Colon & Rectal Surgery (Licence: WA MD61579287) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2024-08-05 |