| NPI | 1164481743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 75212) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: MA 75212) |
| 2086S0120X Surgery Pediatric Surgery (Licence: MA 75212) | |
| 2086S0127X Surgery Trauma Surgery (Licence: MA 75212) | |
| 2086X0206X Surgery Surgical Oncology (Licence: MA 75212) | |
| 208C00000X Colon & Rectal Surgery (Licence: MA 75212) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2012-05-18 |