| NPI | 1619076056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO 2012011934) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2012011934) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-04-17 |