| NPI | 1194068320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 75897) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 20855) |
| Enumeration Date | 2013-04-06 |
| Last Update Date | 2024-04-18 |