NPI | 1225560824 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME173030) |
Additional Taxonomies | 208600000X Surgery (Licence: FL ME173030) |
Enumeration Date | 2017-04-01 |
Last Update Date | 2025-07-13 |