NPI | 1083731525 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101031444) |
Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NC 9400174) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2008-02-08 |