| NPI | 1396708418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MT MED-PHYS-LIC-132495) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 7018) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2024-01-18 |