| NPI | 1124061411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 10064) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MT 10064) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2011-08-08 |