| NPI | 1194222638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CO DR.0077907) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 3018152) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2026-09-16 |