| NPI | 1376863274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 66219) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2018031091) |
| 208C00000X Colon & Rectal Surgery (Licence: MO 2018031091) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2019-08-15 |