| NPI | 1124175070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 52312) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT185871) |
| 208600000X Surgery (Licence: PA MD434531) | |
| 208C00000X Colon & Rectal Surgery (Licence: MN 55358) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-06-29 |