| NPI | 1154359354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2015-01794) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 222364) |
| 208C00000X Colon & Rectal Surgery (Licence: NY 222364) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-08-26 |