| NPI | 1538291547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD20653) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD20653) |
| 208C00000X Colon & Rectal Surgery (Licence: OR MD20653) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-04-17 |