| NPI | 1629418017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101257212) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101257212) |
| 208600000X Surgery (Licence: VA 0101257212) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2024-08-14 |