| NPI | 1174903488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2021023199) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 11018234A) |
| 208C00000X Colon & Rectal Surgery (Licence: IL 125.075514) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2021-08-30 |