| NPI | 1114955275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 20545) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WI 20545) |
| 208C00000X Colon & Rectal Surgery (Licence: MN 50758) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2014-10-02 |