NPI | 1932528684 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208600000X Surgery (Licence: CA 183863) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101258985) |
208C00000X Colon & Rectal Surgery (Licence: CA 183863) | |
Enumeration Date | 2014-04-09 |
Last Update Date | 2024-11-20 |