| NPI | 1518200666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD61192361) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 62712-20) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2021-11-12 |