| NPI | 1568534915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA C195160) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60465075) |
| 208D00000X General Practice (Licence: HI MD-13570) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2024-08-08 |