| NPI | 1093796203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 200101036) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 73992) |
| 208C00000X Colon & Rectal Surgery (Licence: NC 73992) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2023-04-17 |