| NPI | 1710137401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 108490) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: UT 8505128-1205) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2021-11-29 |