| NPI | 1700010394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NC 2020-04575) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 074466) |
| 208600000X Surgery (Licence: NC 2020-04575) | |
| 208C00000X Colon & Rectal Surgery (Licence: GA 074466) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2023-02-02 |