| NPI | 1538250394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD26075) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OR MD26075) |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: OR MD26075) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-03-07 |