| NPI | 1215127790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0078278) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD040665) |
| 208600000X Surgery (Licence: MA 232879) | |
| 208600000X Surgery (Licence: VA 0101263681) | |
| 208C00000X Colon & Rectal Surgery (Licence: NJ 25MA09298500) | |
| 208C00000X Colon & Rectal Surgery (Licence: MD D0078278) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2019-08-31 |