| NPI | 1902163710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A128935) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A128935) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MT216910) | |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD464833) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2020-03-10 |