| NPI | 1760903363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: ID M-13990) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME133177) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2018-07-19 |