| NPI | 1316397268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 83798-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016017331) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2024-08-03 |