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 |