| NPI | 1538125000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME92642) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J5625) |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME92642) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2018-11-28 |