| NPI | 1316177876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301504854) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD461918) |
| Enumeration Date | 2009-07-19 |
| Last Update Date | 2021-09-21 |