NPI | 1447218557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA OS005245L) |
Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NJ 25MB04161500) |
208C00000X Colon & Rectal Surgery (Licence: FL OS8396) | |
Enumeration Date | 2006-05-01 |
Last Update Date | 2007-07-08 |