| NPI | 1205078649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME124589) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN 13872) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2020-08-07 |