| NPI | 1134212913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO 2013029750) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: KS 04-36763) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-01-28 |