| NPI | 1316941123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX Q6358) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO R6G45) |
| 208C00000X Colon & Rectal Surgery (Licence: MO R6G45) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2022-04-07 |