| NPI | 1558558320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301102175) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: AZ 40932) |
| 208C00000X Colon & Rectal Surgery (Licence: MI 4301102175) | |
| 2086S0127X Surgery, Trauma Surgery (Licence: PA MD431576) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2023-07-17 |