| NPI | 1487185435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101282796) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 226901) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2024-12-03 |