| NPI | 1720049539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD14812) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: DC MD14812) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2015-10-08 |