| NPI | 1790863884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: CA G64755) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 482751) |
| 208C00000X Colon & Rectal Surgery (Licence: CA G64755) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2021-06-28 |