| NPI | 1639263973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TN MD46108) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD46108) |
| 208600000X Surgery (Licence: MO T2004015309) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-03-29 |