| NPI | 1215255088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD60268393) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60268393) |
| 2086S0127X Surgery, Trauma Surgery (Licence: WA MD60268393) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2025-04-01 |