| NPI | 1417367517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A182814) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: RI CLP05173) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2024-06-27 |