| NPI | 1881823821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101260090) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 240934) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2016-09-02 |