| NPI | 1730406901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A148973) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 32837) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2022-08-18 |