| NPI | 1356837926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 76716) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 29134) |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2024-08-21 |