| NPI | 1295890440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 605665) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD069008L) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD069008L) | |
| 208C00000X Colon & Rectal Surgery (Licence: MD D0078428) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA 605665) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2019-09-25 |