| NPI | 1023052537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: RI MD12780) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: VA 010123650) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2020-01-29 |