| 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 |