| NPI | 1578919817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME176840) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 82270) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2026-05-20 |