| NPI | 1871808949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX T7258) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301109881) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2023-06-29 |