| NPI | 1376507418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: LA MD.10762R) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: KY TP534) |
| 208600000X Surgery (Licence: KY TP534) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2012-12-04 |