| NPI | 1992062855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: TN 64847) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: FL ME138979) |
| 208600000X Surgery (Licence: FL ME138979) | |
| 208600000X Surgery (Licence: TN 64847) | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2022-03-23 |