| NPI | 1982666152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G23626) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: CA G23626) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2015-01-28 |