| NPI | 1679740419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AZ 55713) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 27060) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-02-16 |