| 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 |