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 |