| NPI | 1326606690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 80590) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT217949) |
| 208600000X Surgery (Licence: CT 80590) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2025-08-27 |