| NPI | 1124043591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX G1345) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G1345) |
| 208C00000X Colon & Rectal Surgery (Licence: TX G1345) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2013-04-30 |