| NPI | 1790733038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX J0006) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J0006) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2022-01-25 |