| NPI | 1821353517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD468995) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: PA MD468995) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2020-03-17 |