| NPI | 1932106853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 26223) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA G84346) |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD050553L) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-10-18 |