| NPI | 1699731265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME0070394) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 70394) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2014-10-08 |