| NPI | 1104801208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD60662688) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 133071) |
| 208600000X Surgery (Licence: OR MD24744) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA 133071) | |
| 208C00000X Colon & Rectal Surgery (Licence: OR MD24744) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2022-12-07 |