| NPI | 1205082229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: KY 48468) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 5761) |
| 208C00000X Colon & Rectal Surgery (Licence: MN 56267) | |
| 208C00000X Colon & Rectal Surgery (Licence: KY TP602) | |
| 208C00000X Colon & Rectal Surgery (Licence: NE 27913) | |
| Enumeration Date | 2008-08-10 |
| Last Update Date | 2022-04-14 |