| NPI | 1063855898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO 2018015473) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: KS 04-42290) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2020-06-08 |