| NPI | 1104072230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 98864) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NH 20807) |
| 208600000X Surgery (Licence: NH 20807) | |
| 208600000X Surgery (Licence: OH 35.127088) | |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2025-10-29 |