| NPI | 1538144647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D69531) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: AZ 33553) |
| 208600000X Surgery (Licence: TX U7673) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2026-08-11 |