| NPI | 1841398138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TX R9372) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO T2005014364) |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME111589) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-04-19 |