| NPI | 1912108465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PR 17606) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 26222-r) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-03-03 |