| NPI | 1124021654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G74789) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: CA G74789) |
| 2086X0206X Surgery, Surgical Oncology (Licence: CA G74789) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA G74789) | |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2023-01-26 |