| NPI | 1336125194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101241724) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101241724) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2017-09-01 |