| NPI | 1952614265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL MFC1849) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL MFC1849) |
| 208C00000X Colon & Rectal Surgery (Licence: IL 036.133844) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2021-11-02 |