| NPI | 1902934755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NC 201300204) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 127312) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-07-10 |