| NPI | 1548294580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 19900) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: SC 14371) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-01-13 |