| NPI | 1255451423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD464343) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MN 49859) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2018-08-16 |