| NPI | 1295712370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 25628) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL ME52996) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2008-05-06 |