| NPI | 1952452799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA G45890) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G454890) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2010-09-14 |