| NPI | 1538325295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: KY 52697) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 52697) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2019-10-08 |