| NPI | 1679548614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101258483) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 14302) |
| 208C00000X Colon & Rectal Surgery (Licence: SC 14302) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2016-09-09 |