| NPI | 1720052285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101239531) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NC 34937) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2024-05-24 |