| NPI | 1710189527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301085444) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301085444) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2023-10-09 |