| NPI | 1013005578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301046103) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301046103) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-03-29 |