| NPI | 1821014903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: WA MD60664479) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: UT 5306253-1205) |
| 174400000X Specialist (Licence: UT 53062531205) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-05-25 |