| NPI | 1609985613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MD d0026752) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: DC md11630) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-10-16 |