| NPI | 1346500386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 87668) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2018-00638) |
| 208600000X Surgery (Licence: SC LL34674) | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2023-06-05 |