| NPI | 1578609012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 22824) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: NC 22824) |
| 2086S0129X Surgery, Vascular Surgery (Licence: NC 22824) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: NC 22824) | |
| 208C00000X Colon & Rectal Surgery (Licence: NC 22824) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |