| NPI | 1225686413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 82328) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: TX 47259) |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2026-04-23 |