| NPI | 1902160195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A170752) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A170752) |
| 208600000X Surgery (Licence: MI 4301109269) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2021-01-18 |