| NPI | 1578769923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA 20A12901) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NM A-1419-07) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2013-10-09 |