| NPI | 1740226570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: MD D94615) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D94615) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD437244) | |
| 208C00000X Colon & Rectal Surgery (Licence: WA MD60218352) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2022-11-14 |