| NPI | 1528192218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD170539) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301086125) |
| 208C00000X Colon & Rectal Surgery (Licence: MI 4301086125) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-05-16 |