| NPI | 1649430430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: OR MD178228) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN12927) |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2018-12-06 |