| NPI | 1295173763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OR MD194774) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA MD60979011) |
| 208C00000X Colon & Rectal Surgery (Licence: FL 135903) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2021-02-17 |