NPI | 1295267896 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: UT 10955775-1205) |
Additional Taxonomies | 208600000X Surgery (Licence: UT 10955775-1205) |
Enumeration Date | 2017-04-01 |
Last Update Date | 2025-05-29 |