| NPI | 1154424232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101037826) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: VA 0101037826) |
| 208000000X Pediatrics (Licence: VA 0101037826) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2017-12-11 |