| NPI | 1184768624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 64486) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA g058238) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2020-03-17 |