| NPI | 1497945968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: GA 074740) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CT 51826) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2015-09-11 |