| NPI | 1285782987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A137030) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NC 2013-00733) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-04-22 |