| 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 |