| NPI | 1881636447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 40340) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 040340) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2024-03-21 |