| NPI | 1760563381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX H9957) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: TX H9957) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-04-20 |