| NPI | 1396777926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA BC61205873) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OR MD176699) |
| 208600000X Surgery (Licence: WA BC61205873) | |
| 208600000X Surgery (Licence: WI 49366) | |
| 208C00000X Colon & Rectal Surgery (Licence: KY 43060) | |
| 208600000X Surgery (Licence: MD D71895) | |
| 208C00000X Colon & Rectal Surgery (Licence: MO 2008017345) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2021-08-03 |