| NPI | 1265840243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NE 33755) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 7300) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2021-08-05 |