| NPI | 1386088565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 73453) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 73453) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2026-03-26 |