| NPI | 1225470354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A134883) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: TX S6980) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2025-08-25 |