| NPI | 1629050059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 30509) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI BG086607) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2010-11-08 |