| NPI | 1114975067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 301133) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: GA 057299) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2016-07-15 |