| NPI | 1225152515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A52198) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A52198) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2025-09-11 |