| NPI | 1083709562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 26992) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: NY 246712) |
| 208600000X Surgery (Licence: NY 246712) | |
| 208600000X Surgery (Licence: OH 35060450V) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-04-07 |