| NPI | 1275705253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101252033) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101252033) |
| 208600000X Surgery (Licence: PA MT188562) | |
| Enumeration Date | 2008-03-30 |
| Last Update Date | 2022-02-17 |