| NPI | 1770652752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR Pending) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA Pending) |
| 208C00000X Colon & Rectal Surgery (Licence: OR Pending) | |
| 208C00000X Colon & Rectal Surgery (Licence: WA Pending) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2015-08-19 |