| NPI | 1174865703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 68613) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0080737) |
| 208600000X Surgery (Licence: MD P29146) | |
| 208C00000X Colon & Rectal Surgery (Licence: CT 68613) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2023-03-15 |