| NPI | 1619919859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MD D23525) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0023525) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2013-05-09 |