| NPI | 1689692105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX P4647) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MO R7B36) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2017-04-20 |