| NPI | 1750393591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MD D59199) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D59199) |
| 208600000X Surgery (Licence: TN 49286) | |
| 208C00000X Colon & Rectal Surgery (Licence: TN 49286) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2014-04-14 |