| NPI | 1588677801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX E6598) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: TX E6598) |
| 208C00000X Colon & Rectal Surgery (Licence: TX E6598) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2015-08-04 |