| NPI | 1053390047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME21343) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL ME64544) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2016-10-11 |