| NPI | 1538104443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NV 9336) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 9336) |
| 2086S0102X Surgery Surgical Critical Care (Licence: NV 9336) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2013-02-27 |