| NPI | 1104817857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VA 0101049457) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 266314) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-04-21 |