NPI | 1679695340 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A107821) |
Additional Taxonomies | 208600000X Surgery (Licence: MI 4301082190) |
208600000X Surgery (Licence: CA A107821) | |
Enumeration Date | 2007-04-04 |
Last Update Date | 2021-12-02 |