| NPI | 1265699805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO 2009018415) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2009018415) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2021-02-04 |