| NPI | 1861693947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2011-0410) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NM MD2011-0410) |
| 208C00000X Colon & Rectal Surgery (Licence: UT 9182993-1205) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2011-10-13 |