| NPI | 1538546676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301502519) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 88113) |
| 208C00000X Colon & Rectal Surgery (Licence: GA 88113) | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2024-12-04 |