| NPI | 1154580769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX N4001) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 101254) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2022-07-05 |