| NPI | 1821222480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME117577) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.088987) |
| 208C00000X Colon & Rectal Surgery (Licence: CA A117733) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2013-12-10 |