| NPI | 1467411926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MA 75801) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NH 17496) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2016-09-13 |