| NPI | 1174631782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 290382) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A96750) |
| 208600000X Surgery (Licence: IA 35272) | |
| 208600000X Surgery (Licence: FL ME96547) | |
| 208C00000X Colon & Rectal Surgery (Licence: CA A96750) | |
| 208C00000X Colon & Rectal Surgery (Licence: IA 35272) | |
| 208C00000X Colon & Rectal Surgery (Licence: FL ME96547) | |
| 208C00000X Colon & Rectal Surgery (Licence: NY 290382) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2022-03-13 |