| NPI | 1821014903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA C202417) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA MD60664479) |
| 208C00000X Colon & Rectal Surgery (Licence: UT 5306253-1205) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2025-10-21 |