| NPI | 1336553478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX T8691) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX T8691) |
| 208600000X Surgery (Licence: IL 125-065355) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2023-12-18 |