| NPI | 1679899660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CO 0057147) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX R7169) |
| 208C00000X Colon & Rectal Surgery (Licence: TX R7169) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2023-06-07 |