| NPI | 1700358876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2023-03431) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA Pending) |
| Enumeration Date | 2018-12-29 |
| Last Update Date | 2024-03-06 |