| NPI | 1720200645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WV 23836) |
| Additional Taxonomies | 208600000X Surgery (Licence: WV 23836) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2022-09-15 |