| NPI | 1104803477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 23441) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MN 23441) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2021-09-01 |