| NPI | 1124199211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NY 203151) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 203151) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-08-02 |