| NPI | 1679816821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301031328) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: MI 4301031328) |
| 208C00000X Colon & Rectal Surgery (Licence: MI 4301031328) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2013-04-05 |