| NPI | 1982115358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD61176219) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD61176219) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2025-10-03 |