| NPI | 1669887105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX 27492) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 27492) |
| 208600000X Surgery (Licence: TX 27492) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2025-01-14 |