| NPI | 1053514646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036126490) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 261007) |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2012-08-30 |