| NPI | 1124281530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CT 61554) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 279342) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2018-06-29 |