| NPI | 1477709327 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301094379) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125053962) |
| 208C00000X Colon & Rectal Surgery (Licence: MI 4301094379) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2017-01-09 |