| NPI | 1972695872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101037065) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0101037065) |
| 208C00000X Colon & Rectal Surgery (Licence: VA 0101037065) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-09-26 |