| NPI | 1700093515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101243276) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00047530) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-12-08 |