| NPI | 1174899389 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD472252) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MN 65268) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2025-01-17 |