| NPI | 1104912856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TN 75237) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 75237) |
| 208C00000X Colon & Rectal Surgery (Licence: MO 2003029889) | |
| 208600000X Surgery (Licence: MO 2003029889) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-02-04 |