| NPI | 1518232685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101264822) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 252747) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2019-03-25 |