| NPI | 1104883578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 026182) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CT 026182) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2011-11-30 |