| NPI | 1780649111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2006-00652) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NC 2006-00652) |
| 208C00000X Colon & Rectal Surgery (Licence: LA 15329R) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-05-24 |