| NPI | 1366805780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 99996) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 276994) |
| 208C00000X Colon & Rectal Surgery (Licence: FL 162194) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2024-05-27 |