| NPI | 1558476101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OR MD2121) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA MD00034484) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2022-02-10 |