| NPI | 1760635890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OK 42838) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY R1900) |
| 208C00000X Colon & Rectal Surgery (Licence: AR E-9260) | |
| 208600000X Surgery (Licence: AR E-9260) | |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2024-03-25 |