| NPI | 1649537556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX R7711) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73544) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2026-09-02 |