| NPI | 1497917561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME145797) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 11569477-8905) |
| 208C00000X Colon & Rectal Surgery (Licence: CO 55846) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2020-10-13 |