| NPI | 1710194725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME110089) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA mt185085) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2016-04-14 |