| NPI | 1790940708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: AZ 50719) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MN 64938) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2020-09-08 |