| NPI | 1225448053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A144030) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA A144030) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2021-05-20 |