| NPI | 1174535504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: IA 38721) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 38721) |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME88057) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2026-08-14 |