| NPI | 1639379118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WI 62935-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD041610) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2014-10-16 |