| NPI | 1043558653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A128073) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MN 65602) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2020-09-25 |