| NPI | 1912252321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MI 4301113819) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT202922) |
| 208600000X Surgery (Licence: MI 4301113819) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2021-04-01 |