| NPI | 1245264258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 034772) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 034772) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2008-03-17 |