| NPI | 1700444197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 13849360-1205) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: UT 13849360-1205) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2024-07-07 |