| NPI | 1386900884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: DC MD210001435) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MO 2020022913) |
| 208C00000X Colon & Rectal Surgery (Licence: MD D0092572) | |
| 208C00000X Colon & Rectal Surgery (Licence: VA 0101273351) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2021-10-15 |