| NPI | 1265522601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: KY 47285) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A108787) |
| 208600000X Surgery (Licence: KY 47285) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: AZ 45206) | |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2020-06-03 |