| NPI | 1023190386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 50126) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 50126-020) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2014-01-10 |