| NPI | 1013967033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery |
| 208C00000X Colon & Rectal Surgery | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2007-07-08 |