| NPI | 1528300076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0087887) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MD D87887) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2025-03-25 |