| NPI | 1831105923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD22728) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: OR MD22728) |
| 2086S0127X Surgery Trauma Surgery (Licence: OR MD22728) | |
| 2086X0206X Surgery Surgical Oncology (Licence: OR MD22728) | |
| 208C00000X Colon & Rectal Surgery (Licence: OR MD22728) | |
| 208D00000X General Practice (Licence: OR MD22728) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-09 |