| NPI | 1942438643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: MO 20160000804) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 20160000804) |
| 208600000X Surgery (Licence: MI 4301095056) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2022-01-21 |