| NPI | 1760019046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 14206167-1205) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: UT 14206167-1205) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-07-13 |