| NPI | 1447710488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: LA 353094) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 280551) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-07-05 |