| NPI | 1174641161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: VT 0420012220) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: NY 261340) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-03-27 |