| NPI | 1346801222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 69116) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MN 30216) |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2021-04-28 |