| NPI | 1336377928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AZ 50801) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R71537) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2022-11-11 |