| NPI | 1255480067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A112879) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 217561) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2012-09-19 |