| NPI | 1528222817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX Q4154) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: ME MD19198) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-03-10 |