| NPI | 1386612414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: ID M-11186) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA 35113) |
| 208C00000X Colon & Rectal Surgery (Licence: WA 35113) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2016-11-15 |