| NPI | 1952756389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NC 2023-02292) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME150992) |
| 208600000X Surgery (Licence: NC 2023-02292) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2024-04-17 |