| NPI | 1144544164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: LA 205766) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 205766) |
| 208600000X Surgery (Licence: TN 54562) | |
| 208C00000X Colon & Rectal Surgery (Licence: TN 54562) | |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2018-04-18 |