| NPI | 1134112626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A83995) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L8980) |
| 208C00000X Colon & Rectal Surgery (Licence: TX L8980) | |
| 208600000X Surgery (Licence: CA A83995) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2012-10-26 |