| NPI | 1992124457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AZ 61700) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 61700) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-10-25 |