| NPI | 1427187350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX N6906) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX N6906) |
| 174400000X Specialist (Licence: PA MD425598) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2019-06-28 |