| NPI | 1124085691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 041494) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 041494) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2025-09-11 |