NPI | 1659637502 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: UT 8791046-1205) |
Additional Taxonomies | 208600000X Surgery (Licence: MN 65217) |
208C00000X Colon & Rectal Surgery (Licence: UT 8791046-1205) | |
208C00000X Colon & Rectal Surgery (Licence: MN 65217) | |
Enumeration Date | 2012-04-04 |
Last Update Date | 2021-11-23 |