| NPI | 1083887277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A 1032000) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A103200) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2014-05-05 |