| NPI | 1710951538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: DC MD19200) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD19200) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2014-04-01 |