| NPI | 1477835908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME165332) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME165332) |
| 208600000X Surgery (Licence: LA 311035) | |
| Enumeration Date | 2011-09-10 |
| Last Update Date | 2023-10-24 |