| NPI | 1669834487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CO DR.0068005) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0068005) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-07-26 |