| NPI | 1588892574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX Q0493) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116021560) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2022-01-04 |