| NPI | 1922273903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX P2219) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NV 14747) |
| 208600000X Surgery (Licence: NV 14747) | |
| 208600000X Surgery (Licence: TX P2219) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2026-04-28 |