| NPI | 1437412699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5315055671) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WI 69357-20) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2023-07-19 |