| NPI | 1760914188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NV 27951) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: AZ 70026) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2025-10-22 |