| NPI | 1386628964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 026458) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: CT 026458) |
| 208C00000X Colon & Rectal Surgery (Licence: CT 026458) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2007-07-08 |