| NPI | 1639107394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AR E6532) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: LA MD200284) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2010-10-21 |