| NPI | 1467816074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD70056400) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A150987) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2026-02-10 |