| NPI | 1336460666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 69850-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 69850-20) |
| 208C00000X Colon & Rectal Surgery (Licence: GA 75975) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2021-01-08 |