| NPI | 1417184557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX Q4101) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10034013) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2022-07-12 |