| NPI | 1811359268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301504701) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301504701) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2024-09-27 |