| NPI | 1750387049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD16564) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OR MD16564) |
| 208C00000X Colon & Rectal Surgery (Licence: OR MD16564) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2011-06-27 |