| NPI | 1770078982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: UT 13339040-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 13339040-1205) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2024-01-24 |