| NPI | 1093788879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME102588) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 36251) |
| 208C00000X Colon & Rectal Surgery (Licence: MN 104528) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2016-10-05 |