| NPI | 1134303316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101253957) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 174400000X Specialist (Licence: VA 0101253957) | |
| 208600000X Surgery (Licence: MN 55164) | |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2014-10-16 |