| NPI | 1093975542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301088036) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 5315043189) |
| 208C00000X Colon & Rectal Surgery (Licence: MI FA3020916) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2024-02-06 |