| NPI | 1841340510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MI 4301031237) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI AT031237) |
| 208C00000X Colon & Rectal Surgery (Licence: MI 4301031237) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2022-01-31 |