| NPI | 1063814861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A142567) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036166978) |
| 208C00000X Colon & Rectal Surgery (Licence: IL 036166978) | |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME170321) | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2026-04-19 |