| NPI | 1063405165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD041054E) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA BC2250467) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2008-05-21 |