| NPI | 1578841797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 61826) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 61826) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2024-01-11 |