| NPI | 1124253893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME107209) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT185247) |
| Enumeration Date | 2009-05-24 |
| Last Update Date | 2016-08-16 |