| NPI | 1700872140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 56354) |
| Additional Taxonomies | 208600000X Surgery (Licence: WY 4228A) |
| 208C00000X Colon & Rectal Surgery (Licence: WY 4228A) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2020-02-06 |