| NPI | 1316380751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2021-0248) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NM MD2021-0248) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2021-08-18 |