| NPI | 1588195572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MA 1023009) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.029246) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2025-06-19 |