| NPI | 1376834309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A116809) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 259877) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2017-05-16 |