| NPI | 1265687479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 062060) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL ME101083) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2012-10-02 |