| NPI | 1114929791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301040071) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301040071) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2009-11-02 |