| NPI | 1861806838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 68878) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 7234) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2023-05-25 |