| NPI | 1205493335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL TRN40885) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD490367) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2026-09-03 |