| NPI | 1891742664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00044271) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA MD00044271) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2017-01-30 |