| NPI | 1982711412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 38972) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MI 4301067842) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2021-12-01 |