| NPI | 1548244718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M10571) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101265993) |
| 208600000X Surgery (Licence: GA 048241) | |
| 208600000X Surgery (Licence: WA MD60061899) | |
| 208C00000X Colon & Rectal Surgery (Licence: VA 0101265993) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2020-12-09 |