| NPI | 1518949346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA A34515) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MA 34153) |
| 208C00000X Colon & Rectal Surgery (Licence: MA 34153) | |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2015-05-20 |