NPI | 1124408802 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A163923) |
Additional Taxonomies | 208600000X Surgery (Licence: PA MT208448) |
Enumeration Date | 2015-06-08 |
Last Update Date | 2020-08-27 |