| NPI | 1609281690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301119290) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.064980) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2024-08-31 |