| NPI | 1659603678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME141211) |
| Additional Taxonomies | 208600000X Surgery (Licence: ME MD20195) |
| 208600000X Surgery (Licence: MD P24855) | |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2019-11-01 |