| NPI | 1437265907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD00015395) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD00015395) |
| 174400000X Specialist (Licence: WA MD00015395) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2015-01-05 |