| NPI | 1841686441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61574196) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA MD61574196) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2024-08-15 |