| NPI | 1255301818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 40985) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MN 40985) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2020-08-18 |