| NPI | 1427054022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: LA LA11148R) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: LA LA11148R) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2024-08-07 |