| NPI | 1467537159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AZ 4257) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 4257) |
| 207Q00000X Family Medicine (Licence: AZ 4257) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2021-10-04 |