| NPI | 1821119926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX F5004) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX F5004) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2010-04-21 |