| NPI | 1316220429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 56849) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT199113) |
| 208C00000X Colon & Rectal Surgery (Licence: DC MD044113) | |
| Enumeration Date | 2011-09-25 |
| Last Update Date | 2021-06-29 |