| NPI | 1578551032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL 78773) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME78773) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2010-06-13 |