NPI | 1467409029 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 47550) |
Additional Taxonomies | 208600000X Surgery (Licence: MN 47550) |
Enumeration Date | 2006-05-28 |
Last Update Date | 2021-02-24 |