| NPI | 1568466944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO R9372) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: KS 0418364) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2010-09-20 |