| NPI | 1174525869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101240155) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PR 11687) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2017-07-25 |