| NPI | 1114186459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD30623856) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60323856) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2021-04-05 |