| NPI | 1154632388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: PA MD457834) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD457834) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2020-08-31 |