| NPI | 1801899141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO MD115610) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MO 115610) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2021-03-16 |