| NPI | 1326364373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A 11162) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: CA 20A11162) |
| 2086X0206X Surgery Surgical Oncology (Licence: CA 20A11162) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA 20A11162) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2022-08-01 |