| NPI | 1669558573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA G39995) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301046027) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2008-09-24 |