| 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 |