| NPI | 1639353329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 101251887) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: VA 0101251887) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2021-02-02 |