| NPI | 1245768365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME151098) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 51134) |
| 208C00000X Colon & Rectal Surgery (Licence: MN 66769) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2021-11-11 |