| NPI | 1497818025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD191833) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA MD60920799) |
| 208C00000X Colon & Rectal Surgery (Licence: MI 4301064070) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-08-17 |