| NPI | 1104024462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 323454) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: MN 104395) |
| 208600000X Surgery (Licence: MA 222907) | |
| 208C00000X Colon & Rectal Surgery (Licence: MN 52135) | |
| 208C00000X Colon & Rectal Surgery (Licence: PA MD440812) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2026-03-16 |