| NPI | 1790902013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-01980) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NC 2022-01980) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-10-11 |