| NPI | 1467486563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX N5634) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101231880) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-04-23 |