| NPI | 1457648115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2019-0231) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM RS2018-0637) |
| 208600000X Surgery (Licence: KS 7757) | |
| 208C00000X Colon & Rectal Surgery (Licence: RI LP03632) | |
| 208C00000X Colon & Rectal Surgery (Licence: KS 04-39443) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2023-07-13 |