| NPI | 1093762908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R8884) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 35220) |
| 208C00000X Colon & Rectal Surgery (Licence: NV 19367) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2025-07-10 |