| NPI | 1689892481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MA 276936) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD440587) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MT197896) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2018-09-05 |