| NPI | 1598733941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: UT 93632391205) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M2017) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2021-11-11 |