| NPI | 1881695286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA G71920) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA G071920) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2012-06-19 |