| NPI | 1669404042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME137100) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD417135) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD417135) | |
| 208C00000X Colon & Rectal Surgery (Licence: MA 235865) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-05-29 |