| NPI | 1487382370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME162453) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL TRN36421) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2023-05-18 |