| NPI | 1225560824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME173030) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME173030) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2025-07-13 |