| NPI | 1871552869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX M0150) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA MD203738) |
| 208600000X Surgery (Licence: TX M0150) | |
| 208600000X Surgery (Licence: TN 49193) | |
| 208C00000X Colon & Rectal Surgery (Licence: LA MD203738) | |
| 208C00000X Colon & Rectal Surgery (Licence: TN 49193) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2020-10-06 |