| NPI | 1114993706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO MD101311) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MO 101311) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2019-07-18 |