| NPI | 1255824041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NC 2024-02222) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2024-02222) |
| 208600000X Surgery (Licence: SC LL52558) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-09-05 |