| NPI | 1922007152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 00A822480) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: CA 00A822480) |
| 2086S0127X Surgery, Trauma Surgery (Licence: CA 00A822480) | |
| 2086S0129X (Licence: CA 00A822480) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: CA OOA822480) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA 00A822480) | |
| 208D00000X General Practice (Licence: CA 00A822480) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-08-30 |