| NPI | 1104212711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TN 65962) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 210170) |
| 208600000X Surgery (Licence: TN 65962) | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2022-08-15 |