| NPI | 1174622518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 074669) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL ME135852) |
| 208600000X Surgery (Licence: FL ME135852) | |
| 208600000X Surgery (Licence: GA 074669) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2026-02-09 |