| NPI | 1255770160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NE 28741) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 7017) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2021-08-09 |