| NPI | 1205193760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: ID m-15847) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-15847) |
| 208600000X Surgery (Licence: FL ME137221) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2025-11-13 |