| NPI | 1245209303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD.39106) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00026491) |
| 208C00000X Colon & Rectal Surgery (Licence: WA MD00026491) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-09-15 |