| NPI | 1568637387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MD D83870) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD 3719) |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME122929) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2018-08-28 |