| NPI | 1689678096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO 104225) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: KS 0430049) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2022-01-24 |