| NPI | 1790969780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MN 53485) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 001510) |
| 208C00000X Colon & Rectal Surgery (Licence: MN 104964) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2011-08-25 |