| NPI | 1013216589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: FL ME150140) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 269917) |
| 208600000X Surgery (Licence: OH 35.140642) | |
| 208600000X Surgery (Licence: FL ME150140) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: OH 35.140642) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: FL ME150140) | |
| 2086X0206X Surgery, Surgical Oncology (Licence: NY 269917) | |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2023-07-28 |