| NPI | 1821298191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 101489) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD456698) |
| 208600000X Surgery (Licence: GA 101489) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2026-06-29 |