| NPI | 1245458082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: RI LP00968) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: TN 48676) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2014-02-04 |