| NPI | 1629638291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX V7840) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX V7840) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2025-07-02 |