| NPI | 1790760387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD15391) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: OR MD15391) |
| 2086S0129X Surgery Vascular Surgery (Licence: OR MD15391) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2019-08-30 |